| ObjectivesIn this study,inpatients with active rheumatoid arthritis and interstitial lung disease(RAILD)in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine in the past 8 years were used as the research object to explore the clinical characteristics,syndromes and treatments of patients with active RA-ILD.It is hoped to provide reference for future clinical treatment and research.MethodsThis study is a retrospective study.The clinical data of RA-ILD patients who were hospitalized in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from January 2013 to December 2020 were collected.The patients were classified according to the diagnostic criteria of TCM syndromes.Rheumatoid arthritis(RA)disease activity criteria divide patients into disease activity groups,and record the patient’s general condition,joint condition,DAS28 score,laboratory examination,lung imaging examination and Chinese medicine prescription.The patient information is sorted and entered into an Excel table,and statistical software is used to analyze the clinical characteristics and the law of syndromes and treatments of the patients.Results1.The 127 patients included in this study included 24 males,accounting for 18.9%,and103 females,accounting for 81.1%.The average age was 62.46±12.42 years,the minimum age was 25 years old,and the maximum age was 90 years old.The average course of disease was 8.83±9.61 years,the shortest course was 3 months,and the longest course was 50 years.The main clinical symptoms were joint and pulmonary symptoms.127 patients had joint swelling and pain;the pulmonary symptoms were mainly cough,sputum,chest tightness,chest pain,wheezing and dyspnea,and 93 cases(73.2%)had respiratory symptoms,34 cases(26.8%)had no respiratory symptoms,of which 81 cases(63.8%)had cough symptoms,56cases(44.1%)had sputum symptoms,32 cases(25.2)had asthma symptoms,and 27 cases(21.3%)had symptoms For chest tightness symptoms,5 cases(3.9%)had chest pain symptoms,and 2 cases(1.6%)had symptoms of dyspnea.2.105 of the 127 patients included in this study underwent pulmonary function tests,6(5.7%)patients had normal pulmonary ventilation function,and 99 patients had abnormal ventilation function,including 77 cases(73.3%)with restrictive ventilation disorders,mixed16 cases(15.2%)of sexual ventilation function,6 cases(5.7%)of obstructive ventilation function;8 cases(7.6%)of patients with lung diffusion function were normal,and a total of97 cases of diffusive function decreased,including 57 cases(54.3%)with mild decrease There were 37 cases(35.2%)with a moderate decrease and 3 cases(2.9%)with a severe decrease.All 127 patients underwent pulmonary imaging examination.The imaging findings of 126 patients had two or more abnormal signs.The specific manifestations were as follows:strip shadow 70 times(accounting for 55.1% of patients),grid shadow 50 times(accounting for 39.3% of patients),28 times of patchy shadows(22% of patients),20 times of flakes(accounting for 15.7% of patients),15 times of honeycomb(accounting for 11.8% of patients),ground glass There were 9 times of shadows(7.1% of patients)and 8 times of spotted shadows(6.3% of patients).3.The 127 patients included in this study were classified according to the diagnostic criteria of RA TCM syndromes,and they were arranged in descending order of distribution frequency as follows: 33 cases of wind-cold dampness syndrome(26%),and 26 cases of damp-heat arthralgia syndrome(20.5%)25 cases(19.7%)of phlegm stasis and arthralgia syndrome,23 cases(18.1%)of liver and kidney deficiency syndrome,20 cases(15.7%)of deficiency of both qi and blood,among which the wind-cold-dampness syndrome was the most frequent.4.The 127 patients included in this study were grouped according to the RA disease activity criteria as follows: 11 cases(8.7%)in the low-activity group,55 cases(43.30%)in the medium-activity group,and 61 cases(48.00%)in the high-activity group).There was no significant difference in gender,smoking history,drinking history,age,course of disease,distribution of TCM syndromes,lung imaging manifestations,and white blood cell(WBC)of patients with different disease activity groups of low,medium and high(P>0.05),and differences in low,medium and high There were statistically significant differences in chest pain symptoms,hemoglobin(HGB),platelets(PLT),C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)among patients in the disease activity group(P<0.05).5.A total of 127 Chinese medicine prescriptions were included in this study,involving a total of 158 Chinese medicines,a total of 1509 medicines appeared frequency,55 Chinese medicines with a medicine frequency of ≥10,and the top ten using frequency are as follows:Licorice,Poria,Coix seed Atractylodes,Pinellia,Radix Paeoniae Alba,Almond,Cassia twig,Platycodon grandiflorum,Tangerine peel.The Chinese medicine categories ranked in the top five in terms of their frequency of use are as follows: tonic drugs(24.5%),phlegm and cough and asthma drugs(16.2%),heat-clearing drugs(11.3%),anti-epidemic drugs(10.3%),diuretics Dampness medicine(9.9%).The Chinese medicine categories ranked in the top five in terms of the frequency of use of sub-categories are as follows: qi medicine(14.84%),diuresis and swelling medicine(8.28%),divergent wind-cold medicine(7.89%),cough and asthma medicine(6.56%),clearing Heat-reducing phlegm medicine(6.03%).A total of 12 types of drug combinations were obtained through systematic cluster analysis of 55 traditional Chinese medicines with a frequency of medication ≥10.Through the analysis of the association rules of 158 traditional Chinese medicines,a total of 14 groups of commonly used medicine pairs are obtained,and the combination of Radix Paeoniae Alba and Anemarrhena is the highest.6.This study compared the use of two groups of traditional Chinese medicines with lowmedium activity and high-activity.It is found that 158 traditional Chinese medicines of Platycodon grandiflorum,turmeric,white peony root,Zhimu,Fangfeng,and Qianghuo are both in low-medium activity and high-activity.There was a statistically significant difference in the frequency of use between the two groups(P<0.05).There was a statistically significant difference in the frequency of use of the phlegm-relieving cough and asthmatic drugs between the low-to-moderate and high-activity groups(P<0.05).Conclusion1.Clinical features: Active RA-ILD patients are more common in middle-aged and elderly women,with a long course of disease.The main clinical symptoms are joint swelling and pain(127 cases),93 patients have respiratory symptoms,and 34 patients have no respiratory symptoms.The main pulmonary ventilation function was restrictive ventilation disorder(77 cases),and the main pulmonary diffusion function was slightly decreased(57cases).The imaging manifestations of the lungs are mainly striped shadows,grid shadows and patchy shadows.The higher the RA disease activity,the more patients with chest pain symptoms,the lower the HGB index,the higher the PLT,ESR,and CRP index.2.The law of syndrome and treatment: The common type of RA during the active period is wind-cold-dampness syndrome,followed by damp-heat arthralgia syndrome,phlegm and blood stasis syndrome,liver and kidney insufficiency syndrome,and qi-blood deficiency syndrome.Use high-frequency drugs such as licorice,Poria coix,Coix seed,Atractylodes macrocephala,Pinellia,White peony root,almond,Cassia twig,Platycodon grandiflorum,etc.Commonly used medicine pairs include white peony-Anemarrhena,Coltsfoot-Asters,Kunming Begonia-Dipsacus,etc..The higher the activity of RA,the more drugs used to relieve cough,resolve phlegm and relieve asthma.The basic pathogenesis of RA-ILD in the active period is deficiency and excess,following the treatment principle of “distinguishing the priority,strengthening the body and removing the evil,promoting blood circulation and removing blood stasis,and protecting the spleen and stomach”.The treatment method is to replenish deficiency and strengthen the body,clear away heat and remove evil,resolve phlegm and relieve cough Mainly,supplemented by diuresis and dampness,promoting blood circulation and removing blood stasis,strengthening the spleen and protecting the stomach. |
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